Friday, August 15, 2014

Shoulder Pain: Don’t Let it Keep You from Conquering the Beast

Shoulder Pain: Don’t Let it Keep You from Conquering the
Beast

By Jason Dudzic, PT, MSPT, OCS, Cert. MDT

Jason Dudzic, PT, MSPT, OCS, Cert. MDT, holds board certification in
Orthopaedics from the American Board of Physical Therapy Specialties (ABPTS).
He is one of only three therapists certified in orthopaedics in the Erie area.

The next-gen obstacle races, such as the Beast on the Bay,
require intense training that includes not just in running, but the entire
body.When it comes to training for
these events, upper extremity overuse injuries can be as much of a limiting
factor as the lower extremity injuries that I’ve discussed in previous
blogs.

One of the most common overuse injuries of the shoulder is impingement
syndrome, or the more general term “anterior shoulder pain” (pain in the
front of the shoulder). Although much of the current literature is conflicted
over the causes of “anterior shoulder pain,” most sources agree that it occurs
as a result of altered biomechanics and/or structural abnormalities.There are several different types of
impingement syndrome, including subacromial and internal impingements. But most
commonly, in non-throwing sports, subacromial impingement is what limits the
athlete.

Subacromial impingement occurs when the subacromial bursa
and/or supraspinatus tendon (one of the rotator cuff tendons) gets “pinched”
between the acromion and coracoacromial ligament. This can lead to
bursitis/tendonitis and, if left untreated, can progress to a tear in the
tendon.

Subacromial impingement can be subdivided into primary
impingement and secondary impingement.Primary impingement usually occurs in individuals over the age of 65,
and results when the space between the humerus and acromion is reduced due to
degenerative changes, such as a spur (See Figure B).

A. Normal Shoulder X-Ray

Spurring noted on acromion and humerus

Secondary impingement generally occurs in younger
individuals and is the result of faulty mechanics, muscle imbalances,
hypermobility, or hypomobility of the shoulder capsule.The faulty mechanics can occur at the
glenohumeral joint (ball and socket joint), or the scapulothoracic joint (the
joint between the shoulder blade and rib cage).When the scapulothoracic joint is the cause of impingement, muscle
imbalances around the scapulothoracic joint lead to changes in the angle of the
glenoid (socket), causing the impingement to occur.

With the Barber Beast around
the corner, it’s likely you’ve been doing your upper body training right along
with your running.If you’ve been
noticing anterior shoulder pain during your overhead resistance training,
including monkey bar training, overhead lifts, military presses, etc…you may be
experiencing impingement syndrome.

Start by trying to stretch
the posterior (back) and inferior (bottom) portions of the shoulder capsule,
which allows the head of the humerus to drop down,thus creating space for the
supraspinatus tendon. Do NOT stretch the capsule if you have known hypermobility
in the shoulder or have a history of a shoulder dislocation.

If you’ve performed these
stretches for 10 repetitions, three-to-four times a day forfour-to-five days, and you’ve had no change
or an increase in your pain, you may benefit from evalauation by your physician
or physical therapist.The appropriate
healthcare professionals will determine if your problem is impingement, and
determine if you would benefit from other treatment, such as strengthening,
modalities (heat, ice, electrical stimulation, ultrasound), stretching, or
dynamic stabilization.

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